The brand-name medications below are excluded on the formulary. %�o���(|�h���ÈN%ۏh:�& This is based on the American Academy of Neurology (AAN) and American Headache Society (AHS) ... please call Navitus Customer Care at 1-877-908-6023. Formulary and Tier status as well as pharmacy management programs such as prior authorization, step therapy, brand/ generic difference pricing, and/or quantity limits. Consider lower initial dose. You may reach Navitus Customer Care toll-free at (866) 333-2757. �g�Ȱ��0�DF��3'fN�P�Vd��Z�%"3Gf���92sd��̅��f~0�������nk��M ��$5px.Og�b��p �Yw �֑'8L^&8�S'�K���� �F0uD�������Ǒn�nl����I�/˷ ���y7Yhi� �Z��a�2�Ҍ �{�i& ~��8u����2�1�E��$��f��J5��a�<1�N~�����+��'�hl�\K�6+#a�2��4 ͭ����K�#,���|ɮ�OX�I�G,���Q�F¯�Q5'|�jDiE�b|U���u���H$b/�=�i�]#r*��_�i�� �*Ԗ��6�A`�>�A0n���bCRS��f8�DRSΊ!����\V���.-E�cS��0�sX%W���v��Ǚq�*8�^���&8��ڎ$檚9g� 4���jHf�R�b.U�bN���1�g�E�o��nкID�� �I�}�X�k~��`�2�A`N�(�:�Yn�OpL"�zaa����]l�ƪ��_�I/Hf8�DvGa�}d_َ7N@q�3�+��9e�oӃ����(|� Navitus Web Portal. Such a circadian rhythm release cardiovascular drug delivery system is designed to provide a plasma concentration—time profile, which varies according to physiological need during the day, i.e., mimicking the circadian rhythm and severity/manifestation of a cardiovascular disease, predicted based on pharmaco-kinetic and pharmaco-dynamic considerations and in vitro/in vivo correlations.Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.Gavreto (pralsetinib) is an oral selective RET kinase inhibitor for the...Onureg (azacitidine) is a nucleoside metabolic inhibitor indicated for the...Qdolo (tramadol hydrochloride) is an opioid agonist indicated in adults for ...Xaracoll (bupivacaine hydrochloride) is a fully bioresorbable collagen implant...The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. It is an abridged list of Pharmacy and Therapeutics Committee approved drugs that may be prescribed for Navitus members. InnoPran XL is a brand name of propranolol, approved by the FDA in the following formulation(s): INNOPRAN XL (propranolol hydrochloride - capsule, extended release;oral) Manufacturer: ANI PHARMS INC Approval date: March 12, 2003 Strength(s): 80MG , … Available for Android and iOS devices. :�ޑ�#��:�ܱk�F��0Vc�k�WG�$�z�q!��#I.$RHvuEb�� �i�� �� v�I.v�,�{�D�8}��i �(6Ę�����Df��G� Each drug product is assigned a coverage tier, shown to … Brand name drugs are listed in all upper case letters. Revised July 8, 2020 *Indicates a generic is available without prior authorization This list may not include all available generic formulations listed specifically by name Note: Brand Named Drugs are capitalized, generic drugs start with lower case letters. Effective June 16th, 2020 Non-preferred medications require prior authorization Page 8 of 22 CENTRAL NERVOUS SYSTEM Drug Class Preferred Requires Prior Authorization Anti-Depressants: Others bupropion IR/SR/XL 150, 300 mirtazapine IR trazodone Venlafaxine IR venlafaxine ER caps (OSM 24) Aplenzin® Brintellix® bupropion XL 450 (gen. for Medications are listed by the condition they treat, then listed alphabetically within tiers (or cost-share levels). %�/�N ��JԆ7�%���DN��A"J�$�OD��t$�~����Ci#j�ز�X4���Ɔ��D��;!�Y��Dl��@ Value Formulary non-formulary drug list as of July 1, 2020 | 3 Therapeutic Category Non-Formulary Drug Formulary Alternative Cardiovascular (continued) Beta Blockers Hemangeol, Innopran XL, Kapspargo acebutolol, atenolol, atenolol-chlorthalidone, betaxolol, bisoprolol, bisoprolol-hctz, carteolol, carvedilol [ER], labetalol, metoprolol, metoprolol Beta Blocker Heart Meds Might Pose Special Risks for Women This document is subject to change. There is currently no therapeutically equivalent version of InnoPran XL available in the United States.Patents are granted by the U.S. Patent and Trademark Office at any time during a drug's development and may include a wide range of claims.A unit dosage form, such as a capsule or the like for delivering drugs into the body in a circadian release fashion, is comprising of one or more populations of propranolol-containing particles (beads, pellets, granules, etc.). Refer to the Prescription Drug Formulary online at mvphealthcare.com for more detailed information about coverage and Tier information. InnoPran XL 120 mg (120 InnoPran XL LOGO Reliant) July 1, 2020 Premium Formulary Exclusions ... Inderal XL , Innopran XL propranolol ER Kapspargo metoprolol ER Katerzia amlodipine . InnoPran XL: 80 mg/day PO initially; may be increased every 2-3 weeks until response achieved; maintenance: not to exceed 120 mg/day PO. CHEMOTHERPY AGENTS . PO: 10 mg q6-8hr; may be increased every 3-7 days. 1872 0 obj <>stream